Friday, August 29, 2014

The birth plan part I

The more D day approaches (I trust they call it "labour" for a reason), the more decisions loom and the more we are bombarded with various experts pandering their nostrums for the best birth for mother and baby. Should you bank the cord blood? Eat your placenta? Encapsulate it or cook it? Have a doula? Go to Lamaze classes or Bradley classes or Alexander technique classes? Have an epidural? Give birth at home? At a birth centre? In a hospital? Have first contact? Have the dad cut the umbilical cord? Will you breast feed? What breast pump will you use? Will the baby sleep in your room or in their room? What co-sleeper will you buy? What crib? And so it goes. All the minutia seem to be able to be taken care of by a few clicks on the internet - you can book a doula, a birthing class, a cord blood bank and placenta encapsulation all with a few clicks (I see a future google ad in the works, the clicks that start life).

In aid of some of these decisions, various people tell you to have a ready birth plan. The type where you list you want to listen to David Bowie, have a bath and have nag champa everywhere and then end up going into labour on the subway or having a caesarian, cursing the cosmos that this was NOT in your birth plan. Though I haven't given birth to any child yet, from what I've read and seen, it seems however much you would like to control one of the biggest events in your life, you are but an actor in a script that your baby is writing and directing. I suppose it's only appropriate since from the time the little tykes in your tummy are born, they will be running the show anyway. Mine has already displayed his dictatorial tendencies. He wakes up me up at 5 am daily so that I could eat and he can gorge on yoghurt (he is half Greek).

Before attending any birth class, I decided to do some research and decide which would be the best. The first method I started to look at was the Bradley Method and quickly discarded it. I found his book quite misogynist. Before I was thirty pages in, he had accused women of overcomplicating labour, pointing out that cows and sheep do not seem to have as much of an issue. His thesis to include the dad in a more major role (although not having developed a way the father could of course do the labour himself) and congratulate him on the mother's labour by rewarding him with orange juice also raised an eyebrow from this reader. The dad's part in labour is to take whatever abuse we need to yell at them and withstand our grip. I barely restrained myself from throwing the book across the room. So we crossed that one of that list.

Lamaze, which is not trendy these days, appears to focus on relaxation and breathing and the Alexander Technique (which aided me through a ghastly knee injury a decade ago) focuses on posture. You may wonder why there are so many classes that focus on breathing techniques in labour - we need to breathe to live, so why learn something so natural? Sadly, we don't breathe well in our daily lives (with a tendency to breathe only from the upper lungs and failing to utilize our full breathing potential), let alone breathe well when we are in panic or in pain- and hence the classes, although I wonder how many women remember and utilize the breathing they learnt in class. Contractions can be so painful that women may well not be able to breathe through them, which is why breathing between contractions is so important. One of my issues with these various breathing classes (even in yoga) is that there is so much focus on the particular breathing technique- whether you exhale through your nostrils or through your mouth or which nostril your breathe into and exhale from and how long you inhale and exhale - that some people get so caught up in following the right technique that they get nervous, which affects their breath and they are incapable of breathing as directed. Really, the instructions should be simply- breathe and breathe deep. You may notice that after taking some time to breathe deeply and slowly, you will feel at ease - all those lovely endorphins are rushing through you. The trick is being able to breathe and calm yourself down when you are in panic - for instance, when you have to squeeze out a watermelon in front of strangers.

As far as birthing classes go, I've opted for a yoga workshop with my husband wherein we practice yoga breathing and poses for labour and more importantly, he practices yoga labour message techniques. If I can push out the baby, he can push on my muscles - it only seems fair.

I've been given a hypno birthing tape to listen to, but have not had the pleasure of it yet, so stay tuned. Apparently you shouldn't listen to it before week 34, which is at about the time you are guaranteed a healthy baby, although their lungs aren't quite up to scratch and they need to stay in the incubators for a while. With such a warning, you may wonder how well it works - maybe even women who haven't conceived end the tape with a tyke and a lot of explaining to do.

Everyone has been raving about doulas, but I am a little recalcitrant to have a complete stranger be my birthing coach. I know it may seem a little silly as the hospital staff will all be strangers and the OB is not exactly my BFF and could be one of the three doctors I've only met once or depending on the insanity of the particular day, a complete stranger - but since you can't help all those strange souls, why add another one to the mix? I'm also a little hesitant to have someone so gregarious and ebullient (as the ones I've met all seem to be) holding up pom poms to me when I'm in my most uncomfortable state. I'd rather just yell at my husband like the good ol' times - you did this to me!

I asked my OB about the hospital's policy on epidurals, having decided that I would not have one. It wasn't so much my fear of the effect it may have on my son, although I was concerned, as the fact that I wondered whether an epidural prevents you from feeling the need to push, creating a need for pitocin, which creates a need for a stronger epidural and a downward spiral that may well lead to a caesarian. I decided that for both issues, it was better to err on the side of caution. My OB looked at me, smiled and said, in a tone reminiscent of a rehearsed phrase, "as you wish, but honey, let me tell you, no one is going to give you a medal for not taking pain medication."

How much more painful can contractions be to say, tearing your meniscus or tearing your scapholunate ligament to the point of your bones dislocating or breaking your coccyx? I should be thankful for all my past injuries in preparation for this upcoming pain...of course, it may well pale in comparison, in which case....I could always just yell abuse - it's the only time we're really permitted to, so we might as well as let it all out. Yeah, you. That's right. You look like a wet porcupine!

I am giving birth in hospital, which is not the most magical setting, but considering that the number one cause of death for women for, well, EVER, was childbirth, I've decided to err on the side of caution and be around the minds and equipment that can handle an emergency, should one occur. After all, I've had a terrible medical history so giving birth at home in a blow up pool is just inviting disaster for myself and my son. While I haven't had the tour yet to see the maternity ward, which apparently you can only do with a lactation consultant, I do know that unfortunately Lower Manhattan Presbyterian does NOT have baths, which I was rather looking forward to. I suppose a shower would have to do (which thankfully they do have in the room).

I would have opted for a birthing centre, one that sat as an adjunct to a hospital, if New York had more of them, but the only one we have in the city is connected to St. Luke's and my OB is not affiliated with it. Even if my OB were affiliated with the hospital and my health met their standards, my husband and I would have to be picked from a personal interview in order to be allowed to give birth there - and of course, if it's a full moon and everyone's water breaks, you may get to the centre just late enough to lick the door and be told that it's full and your hospital room awaits you upstairs. I wonder what they ask you in the interview. How many comebacks do the 80s have left?

My prenatal yoga class is full of St. Luke birthing centre mums who beam ebullient during our introductions when the teacher asks everyone how we're feeling, where we're giving birth and whether, if it's not our first, we had a vaginal birth before. I always try and come late to avoid this discussion as it's extremely judgmental for a yoga class and feels quite incongruous. As we go around the room and some women reveal they are pregnant with their second and had a caesarian before, the teacher immediately expresses her sympathies and encourages them to try for a vaginal birth this time around- not bothering to ask whether her student intends on having one in the first place. As most women are having their first child and ecstatic that they are enrolled in St. Luke's birthing centre, the class becomes one big high five for their right decision. As for the rest, to give my example, when I said I was giving birth at Lower Manhattan, the teacher furrowed her brow in horror and with her best encouraging face, said, "well, I'm sure you'll have an OK birth anyway" as the St. Luke mums looked on aghast. I'd like to see them all mid-way through their labour when they are screaming for drugs and being told that they picked a location where they wouldn't have any, but as a consolation prize, they do have a bath.